April 3, 2020

Registered Staff—Right to Refuse Work

Under to Occupational Health and Safety Act (sec 43), most workers have the right to refuse unsafe work.

However, those working in a healthcare setting have a more limited right to refuse work.

You do not have the right to refuse work when

a. It is an inherent part of the job, or a normal condition of a worker’s employment
b. If it would endanger the life, health, or safety of another person

For example, while dealing with infections is an inherent part of a worker’s job in a healthcare facility, doing so without proper PPE is not inherent.

On March 20, the College of Nurses of Ontario (CNO) released a frequently asked questions document that dealt with whether workers can refuse to work with an infected patient. It states that when your professional obligation to a patient conflicts with your personal obligations, you have an accountability to demonstrate leadership and work out the best possible solution while still making decisions in the patient’s best interest.

Refusing assignments or choosing to discontinue care is an ethical dilemma without one clear answer. CNO encourages all nurses to review the Refusing Assignments and Discontinuing Nursing Services practice guideline, because it contains information about resolving this dilemma and also how to prevent such a situation from occurring in the first place.

Ultimately, you do have the right to refuse assignments that you believe will subject you or your patients to an unacceptable level of risk. But you also have a professional accountability to advocate for practice settings that minimize risk to both you and your patients. Advocating for quality practice settings is one of the many ways nurses are leaders in patient care.

CNO’s practice guideline, Refusing Assignments and Discontinuing Nursing Services, states

  • the safety and well-being of the patient is of primary concern,
  • nurses are accountable for their own actions and decisions and do not act solely on the direction of others, and
  • nurses have the right to refuse assignments that they believe will subject them or their patients to an unacceptable level of risk.
  • Abandonment occurs when a nurse has accepted an assignment and discontinues care without

  • the patient requesting the discontinuation,
  • arranging a suitable alternative or replacement service, or
  • allowing a reasonable opportunity for alternative or replacement services.

Nurses should review relevant organizational policies and guidelines related to staffing and workload. If needed, you should advocate for and develop policies and guidelines driven by patient interest and safety.

To summarize, if a nurse has accepted the assignment, she or he may not abandon the patient but must be heard about the need for protection. Consider the violent patient and increased risk to the nurse. The nurse is not allowed to walk out, but must be supported by the employer to be safe and free from violence. The same can be said for infection prevention and control.

Meet with the Infection Control/Joint Health and Safety Committee and talk about the risk of infection and transmission. Ask if they would do the work without the proper equipment. If so, ask them to step up and lead by example.

If you have concerns over the measures your employer is taking or failing to take in response to COVID-19, raise these concerns with your supervisor, health and safety reps, and stewards. The Joint Health and Safety Committee should work with the employer to develop a plan for minimizing risks.